The authors clinically analysed 54 cases of elderly patients beyond 60 years of age with femoral neck fractures. These patients were treated with osteosynthesis procedures (39 cases; Scand pin, Knowles pin, Cannulated hip screw, Dynamic hip screw) and primary replacement surgery(15 cases; Total hip replacement, Bipolar endoprosthesis) from Jan. 1986 to Dec. 1990. All these 54 cases were followed for more than 1 year. The results were assessed by interval from injury to operation, post operative complication and mortality rate, ambulation time, Jesse hip grading method. The results obtained were as follows; 1. The average age of the patients were 66 years in osteosynthesis group and 69 years in primary replacement group. 2. The most frequent cause of the fracture was slip down and fall down. 3. The most frequent fracture type was transcervical in osteosynthesis group and subcapital in primary replacement group. 4. The interval from injury to operation was mostly within 1 week in osteosynthesis group, over 3 weeks in primary replacement group. 5. Post operative ambulation time was earlier in primary replacement group by an average of 1 week than in osteosynthesis group. 6. Although the cause of death could not be identified, the mortality rate was 12.8% in osteosynthesis group and 13.3% in primary replacement. 7. In 39 cases of osteosynthesis, 7 patients were readmitted for secondary replacement surgery due to avascular necrosis of femoral head (6 cases), nonunion (4 cases), metal failure (1 case). The secondary replacement surgery was done mainly for the fracture of Garden stage 3,4 (100%) and subcapital type (71%). 8. The satisfactory results were obtained 61.5% in primary osteosynthesis group and 67% in primary replacement group.